Current estimates of male:female ASD is 4:1, however Simon Baron-Cohen suggests that once female ASD is diagnosed effectively the numbers will change to 2:1. This will change the current 1 out of 68 children affected with autism in the US to 1.5 out of 68.

Criteria developed specifically around males with ASD.

When boys and girls have similar autistic traits, males get diagnosed, but females do not. Females tend to get diagnosed only when they are low functioning. Clinicians are missing many girls who are on the less disabling end of the autism spectrum, previously designated Asperger syndrome.

ALTERNATE DIAGNOSES

Females tend to be diagnosed with other mental illnesses.

23% of women who are diagnosed with eating disorders have ASD symptoms—a percentage much higher than in the general public (3%). [1]

Autism and ADHD tend to co-occur, resulting in many females who are easily distracted being diagnosed with ADHD instead. [2]

Due to one of the diagnostic triad being repetitive and restricted behavior OCD can look a lot like ASD and females are diagnosed with OCD instead. [3]

DIFFERENT NEUROLOGY

Behavioral and preliminary neuroimaging findings suggest that autism manifests differently in girls. Notably, females with autism may be closer to typically developing males in their social abilities than typical girls or boys with autism.

Girls with autism are indeed different from other girls in how their brain analyzes social information. But they are not like boys with autism. Each girl's brain instead looks like that of a typical boy of the same age, with reduced activity in regions normally associated with socializing. “They're still reduced relative to typically developing girls.”

On a measure of friendship quality and empathy, autistic girls scored as high as typically developing boys the same age—but lower than typically developing girls.

MASKING AUTISM

High-functioning girls tend to camouflage or mask their ASD more effectively. This is believed to be due to greater social pressures for girls to camouflage. [4]

A social life does not come naturally to high-functioning females with ASD, but they use their high intelligence to mimic and become excellent actresses when necessary. This often results in identity crises, suicidal ideations and exhaustion.

Females study people they way other people study math—learning the rules via observation, reading novels and applying these rules to social situations.

Autistic girls exhibit less repetitive behavior than the boys do.

Autistic females have socially acceptable obsessions such as research.

The pastimes and preferences of high-functioning female autistics are similar to those of other girls.

Autism is often marked by an absence of pretend play, research finds that this is less true for girls. [5]

EMPATHETIC

A ground-breaking theory called The Intense World Theory suggests people with Asperger’s do not lack empathy – rather, they feel others’ emotions too intensely to cope. Paul Bloom details a level 6 empath:

Hannah is a psychotherapist who has a natural gift for tuning in to how others are feeling. As soon as you walk into her living room, she is already reading your face, your gait, your posture. The first thing she asks you is ‘How are you?’ but this is no perfunctory platitude. Her intonation—even before you have taken off your coat—suggests an invitation to confide, to disclose, to share. Even if you just answer with a short phrase, your tone of voice reveals to her your inner emotional state, and she quickly follows up your answer with ‘You sound a bit sad. What’s happened to upset you?’ Before you know it, you are opening up to this wonderful listener, who interjects only to offer sounds of comfort and concern, to mirror how you feel, occasionally offering soothing words to boost you and make you feel valued. Hannah is not doing this because it is her job to do so. She is like this with her clients, her friends, and even people she has only just met. Hannah’s friends feel cared for by her, and her friendships are built around sharing confidences and offering mutual support. She has an unstoppable drive to empathize.

But consider what it must be like to be her. Hannah’s concern for other people doesn’t derive from particular appreciation or respect for them; her concern is indiscriminate and applies to strangers as well as friends. She also does not endorse a guiding principle based on compassion and kindness. Rather, Hannah is compelled by hyperarousal—her drive is unstoppable. Her experience is the opposite of selfishness but just as extreme. A selfish person might go through life indifferent to the pleasure and pain of others—ninety-nine for him and one for everyone else—while in Hannah’s case, the feelings of others are always in her head—ninety-nine for everyone else and one for her. [6]

Studies have found that when people are overwhelmed by empathetic feelings, they tend to pull back. When someone else’s pain affects you deeply, it can be hard to reach out rather than turn away. For people with autism spectrum disorder, these empathetic feelings might be so intense that they withdraw in a way that appears cold or uncaring.

These girls still often show the social interaction impairments refusing to talk about anything else or take expected conversational turns.

SEXUAL EXPLOITATION

The autistic tendency to be direct and take things literally can make affected girls and women easy prey for sexual exploitation. Furthermore, the desire to fit in makes them feel “the only way to have a relationship with a man is to enter into a relationship sexually”. But Professor Carpenter said that safeguarding autistic girls could be challenging because a “black-and-white thinker” who was “desperate for friends” might believe that engaging in risky behavior was better than the apparent alternative – being “excluded” and “isolated”. [7]

The problem with sexual exploitation is “endemic” among women on the spectrum, particularly because so many are acutely aware of their social isolation. “When you feel you're too difficult to love, you'll love for crumbs.” [8]

LONELINESS

Autistic females who want to connect obsess about what they are missing and are tormented by their loneliness.

66% of adults with high-functioning ASD report being suicidal, the rate is 71% among females. [9]

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